Iowans, it looks like we’re going to see a trifecta. No, I’m not talking about the complete control Republicans have of the Iowa House, Senate, and governor’s seat. I’m talking about our health care.

At the national level, because the Donald Trump administration has refused to support the continuation of the Affordable Care Act policyholder subsidies, we’ve seen insurance companies dropping out — even though before the election, all analyses indicated that the health care marketplaces were stabilizing. Now Iowa is facing a future without any providers.

Finally, Senate Republicans are working on a new version of their American Health Care Act — but no one knows what’s in it. Their plan is to shove it through without committee review, hearings or a Congressional Budget Office score. Why? Because most likely it resembles the House plan that would throw 23 million off health care.

The sad thing? None of this had to be this way.

The Trump administration could have affirmed continuation of the subsidies. Senate Republicans could have simply made modest tweaks to the ACA to keep coverage in place for millions of Americans. And Govs. Terry Branstad and Kim Reynolds could (even now) have reversed their poor decision on Medicaid privatization.

But I’m guessing they won’t — because ideology seems, for them, to trump reality.